Distribution and Localization of Endocrine Cells in the Human Gastro-intestinal Tract -In Relation to Histogenesis of Rectal Carcinoid-

The distribution of endocrine cells in the human intestine was studied by immunostaining using the labeled avidinbiotin technique. The total number of endocrine cells was abundant in the proximal portion of the small intestine and the distal portion of the large intestine. Gastrin, cholecystokinin, and motilin immunoreactive cells were localized in the proximal portion of the small intestine. Peptide YY, serotonin, and glucagon/glicentin immunoreactive cells were distributed more abundantly in the lower large intestine. The serotonin and somatostatin concentrations in the colonic mucosa determined by high-performance liquid chromatography and radioimmunoassay were higher in the distal than proximal portion of the large intestine, being in correlation with the distribution of serotonin and somatostatin immunoreactive cells estimated by immunostaining. Therefore, the regional differences in the number of endocrine cells and the mucosal concentrations of the hormones probably reflect differences in the physiological functions of different regions of the gut. Not many endocrine cells with unknown peptides and animes and immature endocrine cells were present in the lower large intestine. Therefore, the frequent occurrence of carcinoids in the rectum is difficult to explain by the quantitative dominance of endocrine cells alone in the rectal mucosa, and other factors are considered to need evaluation

Endoscopic Polypectomy of Esophageal Leiomyomas; Report of Two Cases

We describe esophageal leiomyomas in two young patients (aged 35 and 32 years), who complained of dysphagia and epigastralgia, which were successfully treated by endoscopic polypectomy. Upper endoscopy showed a pedunculated polyp beneath the normal mucosa located at 28 cm from the incisor in the first case and 1 cm sessile 2.1 cm semipedunculated polypoid lesion in the lower esophagus just above the esophageal-gastric junction in the second case. Both lesions were resected by snare polypectomy without any complication. Light microscopic examination and immunohistochemistry of the tumor tissue confirmed the diagnosis of leiomyoma. Endoscopic polypectomy of esophageal leiomyoma is safe and should be considered as an optional treatment modality whenever possible

Small Colonic Cancer with Invasion of the Subserosal Layer. Report of a Case

Small, flat-type advanced colonic adenocarcinomas are rare. We present a case of small colonic carcinoma invading the subserosal layer. A 61-year-old asymptomatic man was admitted for further examination of positive occult blood test. Barium enema and endoscopic examination revealed a small (10 mm in diameter) flat lesion with elevated margins and a central depression, in the transverse colon. Biopsy specimen taken from the tumor showed poorly differentiated adenocarcinoma. Based on radiologic and endoscopic evaluation, a provisional diagnosis was made of colonic tumor with invasion of the deep submucosal layer. Surgical resection of the transverse colon was performed. The tumor was macroscopically a type IIa + IIc lesion measuring 10 mm in diameter. Histological examination showed poorly differentiated adenocarcinoma infiltrating the subserosal layer. Awareness of this type of tumor should allow early diagnosis and treatment, resulting in improved prognosis

Superficial Depressed Type (IIc) Early Cancer of the Colon : Report of Two Cases

Two cases of superficial depressed type (IIc) early cancer of the colon are reported. Case 1 was a 65-year-old male and case 2 a 69-year old male. The lesion was located in the descending colon in both cases, and was removed by strip biopsy endoscopically in the former and surgically in the latter. The size of the lesion after resection was 6 mm in case 1 and 5 mm in case 2. Histopathologically, both cases were well differentiated adenocarcinoma without adenomatous components, and carcinoma developed de novo by submucosal (sm) invasion. As to the immunohistochemical staining of the cancer tissue by tumor associated antigen, case 1 showed a strong expression of carcinoembrionic antigen (CEA) and partial expression of sialyl Lewisx, and case 2 showed expressions of both CEA and sialyl Lewisx . The nuclear DNA content by flow cytometry was aneuploid only in case 1. Thus, although the two cases were morphologically the same IIc type cancer, the process of carcinogenesis and secondary phenomena varied

Ultraflex Stent Placement for Palliation of Esophageal Cancer

Nine patients with malignant esophageal obstruction were treated with non-covered or covered Ultraflex stents. All patients achieved palliation, six of nine patients showed improvement of at least one dysphagia grade, and five patients could tolerate a normal or near-normal diet. Major (massive bleeding) and minor complications (ingrowth, overgrowth, stent migration, and bleeding) were encountered during follow-up in 2 and 4 patients, respectively. Ultraflex stents for esophageal cancer offer effective palliative treatment and quickly improve dysphagia. However, care should be exercised particularly of potentially serious life-threatening complications such as massive bleeding

Endoscopic Polypectomy of Esophageal Leiomyomas; Report of Two Cases

We describe esophageal leiomyomas in two young patients (aged 35 and 32 years), who complained of dysphagia and epigastralgia, which were successfully treated by endoscopic polypectomy. Upper endoscopy showed a pedunculated polyp beneath the normal mucosa located at 28 cm from the incisor in the first case and 1 cm sessile 2.1 cm semipedunculated polypoid lesion in the lower esophagus just above the esophageal-gastric junction in the second case. Both lesions were resected by snare polypectomy without any complication. Light microscopic examination and immunohistochemistry of the tumor tissue confirmed the diagnosis of leiomyoma. Endoscopic polypectomy of esophageal leiomyoma is safe and should be considered as an optional treatment modality whenever possible